Day in the Life of a Labor Nurse

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Fetal Heart Rate Monitoring (Cheatsheet)
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Outline

Overview

  1. Things to Consider
    1. Technically critical care setting
    2. Emergencies and the unexpected do occur frequently

Nursing Points

General

  1. Key Skills for labor and delivery nurse
    1. Being able to be a support system
    2. Fetal monitoring strips
    3. Neonatal Resuscitation Program (NRP)
    4. Some facilities will have the labor nurse does the newborn care for the first hour
  2. Typical daily routine
    1. Report
    2. Morning scheduled C-sections
    3. Managing pain for the labor patients
    4. Assisting with the delivery of the newborn
    5. Frequent maternal postpartum assessment to prevent a hemorrhage
  3. Challenges
    1. Family drama
    2. The unplanned = patient walks in dilated and ready to deliver NOW
    3. Emergencies = stat c-sections
    4. Handling fetal demises
    5. Unknown newborn chromosomal abnormality
    6. Pain control for the patient

Assessment

  1. Pain assessment for the labor patient
  2. Frequent fundal assessments for the fresh delivery
  3. Fetal monitoring

Therapeutic Management

  1. Pain control

Nursing Concepts

  1. Comfort
  2. Patient education
  3. Patient centered care

Patient Education

  1. What to expect
  2. How to push
  3. The importance of fundal checks

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Transcript

Hey guys, let’s look at what it’s like to be a labor nurse and just a typical day of what this type of nurse experiences. All right. So first I want to tell you guys just some things to consider. So actually labor and delivery is considered a critical care. So you always have to be ready. There’s lots of emergencies that happen and lots of monitoring. So this area is considered critical care. Emergencies do happen. So you have to be really loving the adrenaline rush because a lot can happen and very quickly and unexpectedly.

Let’s go through a typical day. So first you’re going to get report on whatever patient you’re going to have. You might have some scheduled C-sections in the morning, um, or throughout the day, but typically they’re in the morning, so you’ll get report. Maybe have a few C-sections that you have to help be in, scrub for, circulate or whatever the role is at your facility. Pain management. So this is huge. So if you have a labor patient or a C-sections, just going to be helping to get that pain managed, help with getting the epidural in. You assist the anesthesiologists in holding the patient correctly or if they don’t want that, they want to use, just some other like medication like statol for their medication. Then you’re just going to help manage the patient’s pain, how they desire. You are constantly repositioning the patient, so you’re responding to the fetal heart rate and what it’s doing. You might have to adjust the bands on her belly that are holding the monitors, the baby has now spun from over here to over here. So now we gotta adjust the band to make sure we have it on the baby’s back and are measuring the heart rate correctly.

If the fetal heart rate is dropping, then we might need to reposition the patient and turn her to her left side or back to her right side or however, it may be to help fix that, um, heart rate. And then of course you’re going to assist with deliveries. So hopefully it’s your patient that gets the delivers. So you assist with that. A frequent assessment. So this is really important in, this happens a lot in a typical day. So especially our patients that are delivered. So if they’ve had their baby, we’re doing frequent fundal checks to make sure that that fundus is nice and firm and we don’t have a postpartum hemorrhage because all these patients are at a huge risk for that. So some special skills. So you have to work as a support person. Even if there’s a spouse, a partner, whoever in the room, um, the labor nurses looked at as being a huge support for that patient. They have been through this, they’ve seen delivery after delivery. So they need to know, you know, tell dad to, you know, put his hand here and massage back, whatever it may be. Just help to be that support person. Fetal monitoring, so you will learn this, don’t worry. You are going to learn how to read those fetal monitor strips so you can respond when that heart rate drops or all of a sudden is way too high. So you will get trained on that. And that’s really important. The other one is NRP our neonatal resuscitation program. We have a lesson on this. This is for baby resuscitation. Just kind of like your baby life or on basic life support, but for the newborn and the delivery. And even if you’re like, no, I’m a labor nurse, I’m not taking care of the baby.

You still have to know NRP to work in these fields so that you can be a helping hand. And then another special skill is multitasking. So some places, and even that, sometimes the doctor might not make it to the room. Some places the labor nurse catches the baby. So let’s say, uh, the doctor doesn’t make it. Who’s going to catch the baby? Well, that’s going to be you and your other labor friends. Um, usually that doesn’t happen, but it can, sometimes the facility is made that way where the labor nurses do the catching and take care of the patients. So you have to be able to get that baby delivered up on the moms, start the potatoes, then hand the doctor whatever they need. Um, so really being able to multitask. All right, some challenges that can happen, so much family drama can happen. So, um, whatever it may be, families don’t like each other.

You have drama between mom and dad. Um, there can be a lot of drama. So that’s a challenge. But I look at it as there’s drama everywhere, but just be ready for it. Unplanned delivery. So this can be a couple things. You have a woman that comes in off the street and she gets to be 10 centimeters. She’s ready to have a baby. You didn’t even get to introduce yourself right to the patient. She’s just coming in and having a baby so that it could be unplanned. We’ve had people that didn’t know they were pregnant and they’ve come in and had a baby. Um, it could also be people that are having babies that are, um, all of a sudden have a congenital anomaly that they were not expecting. So it was just unplanned. It wasn’t part of their plan for emergencies. So you have to be able to act fast. 

Like I said before you cannot be sitting around. Emergencies can happen so quick that all of a sudden that fetal heart rate drops and you have to be able to respond. And then another challenge, fetal demises. So this happens, there’s fetal death. People deliver stillbirths. You have people that maybe have a death shortly thereafter, needs to be that support person for that mother. So this does happen. I feel like they seem to come in threes that where I work, you know, we know like, okay, we’ll have a rough week where we have a few of them and then it’s better for a little while, but this happens. We one time had a mom come in and her cervix just wasn’t competent. She delivered a baby and it was at, I want to say around 23 weeks and that baby continued to have a heart rate for about an hour. The baby wasn’t really breathing or anything like that, but the heart was still pumping and she did not want to hold her baby. The baby wasnt at that point of viability and she did not want to hold her baby. She did not want to see her baby. And we had to respect that. We didn’t want to tell her that she might regret it. You know, you have to respect their wishes and we did not want that baby to be alone because it’s still had a heart rate. So I stood in the bathroom for 60 minutes and held that baby and it was hard. We did not want it just sitting in a box in a corner.

So fetal demises this happen and sometimes you have to do extra things, um, and be a part of that. So just make sure that that’s a challenge that you are able to face. So some other challenges that can happen are some unknown birth defects. Like I had mentioned before. Sometimes these patients don’t know that and that can be huge challenge to try to help talk them through it and be there for them. Pain control can sometimes be a challenge because everyone’s pain is different. Sometimes the pain management doesn’t work for one, like it does another. So it can be a challenge. Cooperation of the baby, sometimes those little suckers are flipping all over the place. They’re not getting into position the way that they should.

So this can be a challenge because you cannot just tell the baby to do it and it’s gonna do it. And then the last challenge I put here as birth plans. So it’s okay to have a birth plan, but sometimes it can be a challenge. Sometimes you have families that are expecting like all these different things that just can’t happen. Sometimes people come in with a birth plan that and you’re like, “Oh, we already do all that.” Like they want skin to skin the first hour or whatever. So sometimes it works out perfectly. We one time had a midwife who said that the birth plan of the family requested was that everybody in the delivery room was to be naked. Okay. The nurses, the doctors, nobody was doing that. And I know that that is crazy. Yes. But sometimes you’ll get patients like that. So these birth plants can sometimes be a challenge.

All right guys, so some key points here. It is a super rewarding job. You will have hard days, you will have great days. Um, I truly love working in the new life center and um, I hope that if it’s of interest of you that you get into the new life center and love it. So this image here, this is a freshly born newborn, just put up on the mom’s chest. So if you get all the feels when you see that picture, then this could be a great field for you.

Alright. We’d love you guys go out with your best selves today, and as always, happy nursing.

 

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BSN 2 STUDY PLAN

Concepts Covered:

  • Community Health Overview
  • Labor Complications
  • Pregnancy Risks
  • Emergency Care of the Cardiac Patient
  • EENT Disorders
  • Cardiovascular Disorders
  • Childhood Growth and Development
  • Newborn Care
  • Prenatal Concepts
  • Newborn Complications
  • Communication
  • Neurologic and Cognitive Disorders
  • Musculoskeletal Disorders
  • Disorders of the Thyroid & Parathyroid Glands
  • Gastrointestinal Disorders
  • Infectious Disease Disorders
  • Labor and Delivery
  • Postpartum Care
  • Postpartum Complications
  • Respiratory Disorders
  • Fundamentals of Emergency Nursing
  • Oncology Disorders
  • Musculoskeletal Trauma
  • Substance Abuse Disorders
  • Lower GI Disorders
  • Central Nervous System Disorders – Brain
  • Immunological Disorders
  • Disorders of the Adrenal Gland
  • Hematologic Disorders
  • Noninfectious Respiratory Disorder
  • Integumentary Disorders
  • Liver & Gallbladder Disorders
  • Disorders of Pancreas
  • Eating Disorders
  • Microbiology
  • Renal Disorders
  • Female Reproductive Disorders
  • Peripheral Nervous System Disorders
  • Upper GI Disorders
  • Integumentary Disorders
  • Urinary Disorders
  • Neurological Emergencies
  • Learning Pharmacology

Study Plan Lessons

Community Health Course Introduction
Abruptio Placenta for Certified Emergency Nursing (CEN)
Antepartum Testing
Cardiopulmonary Arrest for Certified Emergency Nursing (CEN)
Chorioamnionitis
Cleft Lip and Palate
Congenital Heart Defects (CHD)
Day in the Life of a Labor Nurse
Dystocia
Emergent Delivery for Certified Emergency Nursing (CEN)
Gestational Diabetes (GDM)
Growth & Development – Infants
Hydatidiform Mole (Molar pregnancy)
Infections in Pregnancy
Initial Care of the Newborn (APGAR)
Maternal Risk Factors
Newborn of HIV+ Mother
NRSNG Live | From Student to Real Nurse
Nursing Care Plan (NCP) for Abortion, Spontaneous Abortion, Miscarriage
Nursing Care Plan (NCP) for Abruptio Placentae / Placental abruption
Nursing Care Plan (NCP) for Cerebral Palsy (CP)
Nursing Care Plan (NCP) for Chorioamnionitis
Nursing Care Plan (NCP) for Cleft Lip / Cleft Palate
Nursing Care Plan (NCP) for Clubfoot
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Dystocia
Nursing Care Plan (NCP) for Gestational Diabetes (GDM)
Nursing Care Plan (NCP) for Gestational Hypertension, Preeclampsia, Eclampsia
Nursing Care Plan (NCP) for Hyperemesis Gravidarum
Nursing Care Plan (NCP) for Hypothyroidism
Nursing Care Plan (NCP) for Imperforate Anus
Nursing Care Plan (NCP) for Incompetent Cervix
Nursing Care Plan (NCP) for Maternal-Fetal Dyad Using GTPAL
Nursing Care Plan (NCP) for Meconium Aspiration
Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida
Nursing Care Plan (NCP) for Newborns
Nursing Care Plan (NCP) for Omphalocele
Nursing Care Plan (NCP) for Pertussis / Whooping Cough
Nursing Care Plan (NCP) for Placenta Previa
Nursing Care Plan (NCP) for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM)
Nursing Care Plan (NCP) for Preterm Labor / Premature Labor
Nursing Care Plan (NCP) for Process of Labor
Nursing Care Plan (NCP) for Transient Tachypnea of Newborn
Nursing Care Plan for (NCP) Autism Spectrum Disorder
Nursing Care Plan for (NCP) Fetal Alcohol Syndrome (FAS)
Nursing Case Study for Maternal Newborn
Obstetric Trauma for Certified Emergency Nursing (CEN)
Oxytocin (Pitocin) Nursing Considerations
Placenta Previa for Certified Emergency Nursing (CEN)
Postpartum Discomforts
Postpartum Hemorrhage (PPH)
Postpartum Physiological Maternal Changes
Preeclampsia, Eclampsia, and HELLP Syndrome for Certified Emergency Nursing (CEN)
Preterm Labor for Certified Emergency Nursing (CEN)
Process of Labor
Signs of Pregnancy (Presumptive, Probable, Positive)
Sudden Infant Death Syndrome (SIDS)
Terbutaline (Brethine) Nursing Considerations
Tocolytics
Tocolytics
Transfer and Stabilization for Certified Emergency Nursing (CEN)
Colorectal Cancer (colon rectal cancer)
Complications of Immobility
Constipation and Encopresis (Incontinence)
Cystic Fibrosis (CF)
Liver Function Tests
Nursing Care and Pathophysiology for Crohn’s Disease
Nursing Care and Pathophysiology for Parkinsons
Nursing Care and Pathophysiology for Ulcerative Colitis(UC)
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Acute Kidney Injury
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Anemia
Nursing Care Plan (NCP) for Aspiration
Nursing Care Plan (NCP) for Bladder Cancer
Nursing Care Plan (NCP) for Bone Cancer (Osteosarcoma, Chondrosarcoma, and Ewing Sarcoma)
Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)
Nursing Care Plan (NCP) for Cholecystitis
Nursing Care Plan (NCP) for Chronic Obstructive Pulmonary Disease (COPD)
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Cystic Fibrosis
Nursing Care Plan (NCP) for Decreased Cardiac Output
Nursing Care Plan (NCP) for Dementia
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)
Nursing Care Plan (NCP) for Emphysema
Nursing Care Plan (NCP) for Gout / Gouty Arthritis
Nursing Care Plan (NCP) for Hashimoto’s Thyroiditis
Nursing Care Plan (NCP) for Hyperemesis Gravidarum
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Hypoparathyroidism
Nursing Care Plan (NCP) for Hypothyroidism
Nursing Care Plan (NCP) for Infection
Nursing Care Plan (NCP) for Leukemia
Nursing Care Plan (NCP) for Lung Cancer
Nursing Care Plan (NCP) for Marfan Syndrome
Nursing Care Plan (NCP) for Nephrotic Syndrome
Nursing Care Plan (NCP) for Osteoarthritis (OA), Degenerative Joint Disease
Nursing Care Plan (NCP) for Osteoporosis
Nursing Care Plan (NCP) for Ovarian Cancer
Nursing Care Plan (NCP) for Parkinson’s Disease
Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)
Nursing Care Plan (NCP) for Pressure Ulcer / Decubitus Ulcer (Pressure Injury)
Nursing Care Plan (NCP) for Preterm Labor / Premature Labor
Nursing Care Plan (NCP) for Renal Calculi
Nursing Care Plan (NCP) for Rheumatoid Arthritis (RA)
Nursing Care Plan (NCP) for Stomach Cancer (Gastric Cancer)
Nursing Care Plan (NCP) for Stroke (CVA)
Nursing Care Plan (NCP) for Vomiting / Diarrhea
Nursing Care Plan for (NCP) Autism Spectrum Disorder
Nursing Care Plan for Endometriosis
Nursing Care Plan for Fibromyalgia
Nursing Care Plan for Scleroderma
Nursing Case Study for Diabetic Foot Ulcer
Nutrition Assessments
Stomach Cancer (Gastric Cancer)
The Medical Team
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The SOCK Method of Pharmacology 1 – Live Tutoring Archive